DCH Launches Centralized Prior Authorization Portal
June 1, 2013, DCH will implement the new Centralized Prior Authorization (PA) feature. This feature will allow participating Georgia Medicaid providers to submit PA requests to Fee-for-service (FFS) and Care Management Organizations (CMOs) through one centralized source. A staged development approach will be used so that providers can become familiar with the Centralized PA process.

WellCare provides for a second opinion from an in-network provider or arranges for the member to obtain a second opinion outside the network.

If WellCare is unable to provide a necessary and covered service to a member in-network, WellCare must adequately and timely cover these services out-of-network, for as long as WellCare is unable to provide these services.

If WellCare approves a member to go out-of-network because it is unable to provide a necessary and covered service in-network, WellCare coordinates payment with the out-of-network provider and ensures that the cost to the member is no greater than it would be if the services were furnished in-network.

WellCare requires the hours of operation that providers offer to Medicaid members to be no less than those offered to commercial members.

Planning for Healthy Babies (P4HB®)

Great news! The Planning for Healthy Babies (P4HB®) program is still accepting new participants. Potential participants may apply for the program online, or obtain a paper application at their local health department or DFCS office.

The P4HB® program provides no-cost family planning services to eligible women in Georgia. It also provides additional services such as primary care, substance abuse treatment, and case management including Resource Mothers Outreach to eligible women who have delivered a very low birth weight baby.

Information for Non-Participating Providers
Please note that all of the information listed on this page applies to both participating (in-network) providers and to non-participating (out-of-network) providers. The links below are specifically for non-participating providers:

Forms & Documents
This section is a repository of forms and documents to be used by all providers and institutions when managing care for our members.

Fraud & Abuse
The link provides access for reporting suspected fraudulent and abusive practices by providers and members of the Medicaid and PeachCare for Kids® programs. Learn how to recognize possible fraud and program abuse and report suspicious activities. For your privacy you may remain anonymous.

Pharmacy Services
Click the link to receive information about our available Pharmacy Services, and view the latest Preferred Drug List.

Provider Handbook
The Provider Handbook is a resource for physicians with guidelines on health plan coverage procedures, policies and other information related to the provision of health care services to our members. This document should be used simultaneously with the Quick Reference Guide and the online tools available through the secured area of our Web site.